The purpose of the proposed investigation is to evaluate the effect on the quality and quantity of medical services of the introduction of a new record summary system. The Record Summary is designed with the following objectives: 1) To provide the physician with a convenient, current, concise, legible summary of the patient's record. 2) To identify physician's recommendations which were not carried out. 3) To identify omissions in recording observations and recommended treatment. 4) To identify deficiencies in medical reasoning. 5) To use the information to improve patient care by recommending corrective action. 6) To improve teaching. The experimental design calls for medical students and physicians working in the Cardiac-Pulmonary-Renal Clinic to be assigned to one of three conditions: 1) all their cases will be summarized; 2) one half of their cases will be summarized; 3) none of their cases will be summarized. The experiment will be carried out over a three year period resulting in approximately 80 medical students and 40 physicians working under each condition with a total of approximately 160 patient cases per condition. Evaluation of the effect on care will involve (a) set of specific items which have been selected by a panel of experts which represent current standards of excellence in medical care; (b) questionnaire administered to patients following each visit and designed to assess their attitudes toward the treatment they received and their current physical condition. In addition, other data on morbidity, hospitalization, and further clinic visits will be collected on each case for the light which may be cast on the value of the Record Summary.